Monday, 4 May 2015

LETS GET LYME DISEASE TESTING RIGHT

Three new Lyme Disease tests on the horizon

DNA Sequence Testing

DNA sequencing-based tests for Lyme disease and Lyme disease-like Borrelioses

DNA sequencing, namely the Sanger sequencing technology, is the commonly used “gold standard” for validation of the results of all other nucleic acid-based clinical tests. Ötzi the Iceman who died 5,300 years ago had Lyme disease which was diagnosed in 2012 by DNA sequencing of the genomic DNA remnants of Borrelia burgdorferi preserved in the cadaver. We are using the same approach to diagnose 
Lyme disease and Lyme disease-like borrelioses when the pathogens are still in the blood, in the joint fluid or in the cerebrospinal fluid of a patient. This technology is especially useful in testing for Borrelia miyamotoi infections because its “diagnosis currently relies on the use of tests to detect DNA of the organism”, as stated in a CDC guideline [3]. 

'Researchers at Columbia University are beginning a study of a new test for early Lyme disease.
The study is examining SpiroFind, a test developed in the Netherlands.' 
"The nice thing about this test — if it works as we anticipate it will — is that you will be able to identify active infections in patients in early disease," said Dr. Brian Fallon, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University. "Right now, the tests are only 30-50 percent sensitive in early disease."
This was published by the Poughkeepsie Journal last year.
http://www.poughkeepsiejournal.com/story/news/health/lyme-disease/2014/04/02/new-lyme-test-gets-study/7231729/ 
and 
http://www.poughkeepsiejournal.com/article/20140403/NEWS01/304030023/New-Lyme-test-gets-study

Nanotrap® Lyme Antigen Test (Nanotrap® LA Test)
A GAME CHANGING TOOL FOR LYME DISEASE DIAGNOSIS     

There is a critical need for a fast, reliable, and accurate Lyme disease test

  • The Nanotrap® Lyme Antigen (LA) Test is a novel, high sensitivity, DIRECT test for Lyme that will provide valuable information to assist a physician in diagnosing and treating Lyme disease at most stages of infection.

  • Unlike other clinical Lyme disease tests that are INDIRECT, the Nanotrap® LA Test is a non-invasive test that provides highly sensitive and specific direct detection of the Lyme antigen, Borrelia burgdorferi (Bb), in a patient’s urine sample.

  • The Nanotrap® LA Test can provide valuable information, at anytime in the infection cycle, about the presence of the Bb antigen when used at the time of initial infection, during and after a course of treatment, and in some cases of recurrent disease.


"The winds," says Dr. Richard Horowitz, medical director of the Hudson Valley Healing Arts Center, "are starting to change."
Horowitz believes that in the coming years, research will reveal that a vast number of other conditions commonly viewed as being distinct — such as arthritis or Chronic Fatigue Syndrome — are linked to Lyme.
Dr. Kenneth Liegner, a Pawling-based internist, said treatments will also depend on better tests.

The above is an interesting article in the Poughkeepsie Journal link to the full article

Dr Brian Fallon Key note speaker at a Public Health England meeting in March 2015 said that these are exciting times, regarding research into Lyme Disease. He said that there were one or two promising tests being developed.
 http://lookingatlyme.blogspot.co.uk/2015/03/dr-fallon-presenting-at-lyme-disease.html

The consequences of finding a reliable test for Lyme Disease could have a huge impact on the management of treatment for Lyme disease patients throughout the World.




Friday, 1 May 2015

BARTONELLA - AN EMERGING INFECTIOUS DISEASE




Dr. Edward Breitschwerdt on Bartonellosis - NorVect 2014

Dr. Breitschwerdt talked about Bartonella at the NorVect conference 2014. This is an excerpt of his presentation: Bartonellosis: A One Health Approach to An Emerging Infectious Disease To see all the presentations from both conference days, go to 
http://norvect.no/conference/conference-2014/movie-access/ 


The full presentation is well worth watching with fascinating insights and research that is being done on Bartonella an infection known about for 100 years but very difficult to culture and test for, commonly referred to as cat scratch disease and considered a mild and self limiting disease, Dr Breitschwerdt is finding that is not always the case.
Details of the Norvect Conference 2014 and 2015  http://norvect.no/conference/

In his presentation Dr Breitschwerdt  talks about the difficulties he had in funding his research hence his involvement now with Galaxy Diagnostics 

You can follow some of the interesting developments through Galaxy Diagnostics Facebook page 

I posted previously about Bartonella 

Links to research papers by Dr Breitschwerdt click here

Friday, 24 April 2015

THE BIG TICK PROJECT - THANK YOU CHRIS PACKHAM




A Big Thank you to Chris Packham for launching The Big Tick Project.

'UK Vets launch Big Tick Project to track rising threat of Lyme Disease'

'Throughout spring and early summer when ticks are most active, vets taking part in the Big Tick Project will be giving dogs visiting their practice a tick check. 
The ticks collected by vet practices will be sent for testing to the team of scientists at Bristol University leading the Big Tick Project. 
The team, led by Professor Richard Wall, will be examining the ticks for the presence of Lyme Disease and other tick-borne diseases which it is feared may be emerging in the UK.
Owners whose dogs have taken part in the project at participating vets will receive a Big Tick Project certificate and have helped advance the knowledge surround tick-borne disease in the UK.'


BBC Breakfast started the day 





The more awareness the better the public is prepared to protect themselves and their pets.

Science is still emerging and past opinions are being proved wrong, this Big Tick Project is an excellent opportunity to raise awareness and find out more about ticks and their infections.

Only recently a study done on Grey Squirrels in the North of England and Scotland found that 'Around 12% of the collected squirrels were infected, most commonly by a species of Borrelia usually found in birds.' -- 'Lead researcher Caroline Millins, from the Institute of Biodiversity, Animal Health and Comparative Medicine at the University of Glasgow, said: "Frequent infection of grey squirrels with bird strains of Borrelia was unexpected, and challenges our current understanding of host pathogen interactions for this zoonotic pathogen.' 

http://www.dailymail.co.uk/wires/pa/article-3048908/Squirrels-host-Lyme-disease-bugs.html



Questions being asked - do the current tests used actually pick up this species of Borrelia response from Lyme Disease Action - 'Not as simple as testing for 1 sp or another. UK tests used will detect B garinii infections, but none of the tests are perfect. Serology is an imprecise tool see http://www.lymediseaseaction.org.uk/about-lyme/tests/

As an advocate for patients with Lyme Disease who has seen many media campaigns fail to get even basic information across correctly - how do we get that all so important message across to doctors and the public that there is an over reliance on antibody tests for Lyme disease in early and also late disease?

Saturday, 4 April 2015

COMBINATION ANTIBIOTIC THERAPY FOR LYME DISEASE

Drug Combinations against  Borrelia burgdorferi  Persisters  In Vitro : Eradication Achieved by Using Daptomycin, Cefoperazone and Doxycycline

Once again we have to thank Prof. Ying Zhang for yet a further study on drug combinations against Borrelia Burgdorferi persisters. 

'Daptomycin plus doxycycline and cefoperazone eradicated the most resistant microcolony form of B. burgdorferi persisters and did not yield viable spirochetes upon subculturing, suggesting durable killing that was not achieved by any other two or three drug combinations.'
'As shown in our previous study [16], the stationary phase culture was enriched with morphological variants such as round body form and biofilm-like aggregated microcolony form in increasing proportions in contrast to individual spirochetes found in log phase culture'

This is interesting - 'We also found that miconazole, an imidazole antifungal drug, had high activity against B. burgdorferi persisters when combined with doxycycline and cefoperazone (Table 2). Miconazole has been shown to alter the integrity of lipid membrane [27] and therefore may facilitate the penetration of other drugs such as doxycycline and cefoperazone for improved activity against B. burgdorferi persisters '

Note - 'It is worth noting that short term incubation in subculture studies of antibiotic treated B. burgdorferi is not sufficient to assess the stable eradication of persisters'

'In conclusion, we found there is a hierarchy of B. burgdorferi persisters with increasing antibiotic tolerance as the culture ages from log phase to stationary phase with morphological changes from spirochetal form to round body and microcolony forms. Importantly, we identified drug combinations that have high activity against B. burgdorferi persisters with daptomycin-containing combinations achieving the best activity. The most effective drug combination used daptomycin, cefoperazone and doxycycline which appeared to render resistant microcolony forms of B. burgdorferi unable to resuscitate viability upon subculture, a feature not previously described using any other antibiotic singly or in combinations. While important to state that the role of any persister organisms in human disease is far from elucidated, these findings may have implications for the treatment of certain Lyme disease patients with slow to resolve- or antibiotic-refractory arthritis or possibly stubborn ongoing symptoms. Direct extrapolation of these in vitro findings to human treatment would be unwise and premature. Future studies are needed to confirm whether such combination drug therapy yields benefit in animal models and possibly then in clinical studies.'


Earlier posts on work by Prof Zhang



Lyme Disease Action have done a report of this recent study

Prof Ying Zhang is due to present at this year's LDA conference

To quote Dr Brian Fallon from the recent PHE meeting talking about emerging research 'it is exciting times'.  http://lookingatlyme.blogspot.co.uk/2015/03/dr-fallon-presenting-at-lyme-disease.html  
he also said that there were a few interesting tests in the pipeline.
It is interesting to read that Dr Fallon is involved with this research follow the links from this link

Good tests and treatment options for Borrelia persisters could well be on the horizon and not before time. Then maybe they will get down to identifying and looking at better supportive therapies for other co factors causing our health problems.

A PATIENT VOICE AT PHE MEETING ON LYME DISEASE

A patient speaking at the Public Health Meeting about Lyme Disease held on 29th March 2015 with kind permission to post.

The earlier report of the meeting is posted - http://lookingatlyme.blogspot.co.uk/2015/03/dr-fallon-presenting-at-lyme-disease.html 


Good afternoon everyone.

I am Demetrios Loukas.

Together with my local MP and Minister of Justice, The Rt. Hon. Simon Hughes, I, with the help of Denise Longman who is too ill to be here today, organised the first patient-led parliamentary conference which took place on the 19th January earlier on this year.

The Rt. Hon. Simon Hughes has been following my struggle to obtain adequate treatment for Lyme disease for the past 4 years. After he attended the Worldwide Lyme protest in London last May, he was moved by the plight of so many desperate patients who have been let down by the NHS. He learned that it’s not just the diagnostics that are failing patients but that the treatment offered to those who are lucky enough to test positive is in many cases, failing to eradicate this infection. The consequence of this failure to reliably detect and treat this disease is leaving an untold number of patients like me undiagnosed with chronic debilitating symptoms.

An earlier diagnosis would have saved me a lot of money as well as the Department of Work and Pensions and the NHS. I, like many others, tested negative on the NHS only to find out through a private laboratory in Germany that I that was in fact infected with Lyme Borreliosis and several co-infections. After receiving several long courses of antimicrobial therapy, I am now on the road to recovery; otherwise I would not be here today.

Our patient-led initiative which has been championed by The Rt. Hon. Simon Hughes has procured 1092 signatures approving Dr. Armin Schwarzbach and Dr. Chris Newton as their scientists of choice to work with Dr. Tim Brooks and his team at Porton Down.

For those of you who do not know, Dr. Schwarzbach is both a scientist and a physician, renowned throughout Europe for his expertise in Lyme diagnostics and treatment. Dr. Newton is a research and development scientist with experience in both academia and industry. Furthermore, he is an expert in drug development for the treatment of cancer and chronic disease.
I have come here today to whole-heartedly thank Dr. Tim Brooks for attending the parliamentary conference and for communicating so openly and without hesitation with the Rt. Hon. Simon Hughes and the patient-led initiative’s scientific and medical delegates.

I would like to take this opportunity to commend Dr. Brooks for personally engaging with the patient-led initiative and for inviting Dr. Schwarzbach and Dr. Newton to Porton Down in June to discuss how the current diagnostics used to detect Lyme Borreliosis can be improved.


I would like close my speech by sending out a message of hope to everyone afflicted by this disease: if we really listen to each other, many good things can be achieved for the greater good of all. 

Tuesday, 31 March 2015

THE COUNTESS OF MAR ADDRESSES A PARLIAMENTARY MEETING ON LYME DISEASE

The Countess of Mar has kindly given permission for me to share her Introductory Speech at the Parliamentary meeting on Lyme Disease held in January


Parliamentary debate on the 19th Jan 2015.

On behalf of everybody here may I thank Simon Hughes and his Parliamentary Assistant, Michael Paul for so kindly arranging this meeting on Lyme disease.

Toyber’s dictum is that absence of evidence is not evidence of absence. You might also say that if you don’t look you won’t find. Obviously, people don’t see if they won’t look, but also if they look they might not see. For hundreds of thousands of years humans looked at the planets at night. These “wandering stars” along all heavenly bodies circled the earth. As soon as Galileo looked at Jupiter with a telescope instead of with his naked eye he found four new celestial bodies circulating the planet. Once he reported this discovery the earth centred view of the universe was proven to be incorrect and lead to his persecution and imprisonment.

There are parallels with Lyme disease.

Cultivation of bacteria and looking for them with microscopy has been the gold standard for detecting disease for over 150 years, and is still used by researchers working on Lyme disease to prepare borrelia bacteria for experiments, and to produce antigens for commercial test kits for the disease. However use of microscopy in a clinical environment is attacked and, despite a large number of research projects over the last 20 years which demonstrate persistence of the borrelia spirochetes after standard antibiotic treatment, many people will not open there eyes to this fact.

Vision also seems to be dimmed regarding the incidence of Lyme disease. In the US the Centers for Disease Control and Prevention reported exponential growth of Lyme disease from 1999 to 2006 after which the data levelled off between 20 and 30,000 cases per year. This was not due to a change in tick activity and human infections but was caused by administrative counting problems, and in 2014 the CDC reported that analysis of the evidence indicated that the incidence was 300,000 cases a year - a 10 fold increase.
In Europe, Germany reported that in 2007/8 there were 271 cases per 100,000 people which would represent 213,000 cases for the whole country, and more recent data suggests that by 2010 almost 800,000 patients were diagnosed and treated for Lyme. Using very strict criteria, Scotland report over 16 cases per 100,000 people in Tayside and over 50 cases per 100,000 people in the highlands. Why does England report fewer than 2 cases per 100,000 people? I am sure that ticks have not declared unilateral independence from the Union.

Lyme patients all too often hear that they cannot have Lyme disease. Some of the reasons given are that they don’t live in an endemic area; have no evidence of a tick bite; are negative in a serology test; have been given a dose of antibiotics and so cannot have Lyme, and then they are sent on their way without further investigation or treatment of any sort. This was expressed clearly by an NHS consultant when he said: “Lyme Disease had become a fashionable disease…. is cured by a short course of antibiotics …And: If you have patients with chronic Lyme and seronegative Lyme the put them in touch the Lyme Disease Action charity”.

Surely this is not just passing the buck but abrogation of the duty of care. Does it not try to sweep the inconvenient truth away so that the experts can follow the mad dash to reduce antibiotic use, leaving patients deprived of the treatment they so vitally need to take then from often severe and disabling illness to a level of health were they can contribute to society. They certainly do not want to be a burden… not on their family or on society.


I am looking forward very much to hearing our speakers today and hope that, as a result of this meeting, the diagnosis and treatment for Lyme disease will be advanced.